Destruction of a vitreous body
Destruction of a vitreous body – the pathology of an organ of vision which is followed by violation of physical and chemical properties of colloidal gel of a vitreous body. Clinically the disease is shown by "front sights" and others "floating pomutneniye" before eyes. When progressing decrease in visual acuity is possible. Diagnostics is based on results of an oftalmoskopiya, biomicroscopy, ultrasonography in the mode of V-scanning, an optical coherent tomography, a tonometriya and a vizometriya. Specific methods of treatment are not developed. At early stages conservative therapy is carried out. The expressed destruction is the indication to surgery (a vitreolizisa, a vitrektomiya).
Destruction of a vitreous body
Destruction of a vitreous body call final or partial fracture of structure of this anatomic education. Pathology is most widespread among elderly people. At young people usually results from mechanical injury of an eye or progressing of a miopiya. Representatives of men's and female are ill equally often. Destruction of a vitreous body meets at residents of economically developed countries statistically more often that can be caused by increase in life expectancy, excessive load of eyes in the course of professional activity and some other factors. Modern methods of microsurgery of an eye allow not only to eliminate clinical displays of a disease, but also to partly restore visual functions.
Destruction of a vitreous body happens at change of physical and chemical characteristics of its colloidal gel as a result of a local inflammation of an eye and surrounding fabrics (at an endoftalmita, a keratita, a blefarita, a dakriotsistita). The structure of colloids depends on a functional condition of a liver, kidneys and endocrine glands. At dysfunction of the listed bodies the physiological ratio of liquid, proteoglikan, glikozaminoglikan and components of a stroma is broken. Disorders of metabolism, pathological changes of vessels of a retina and brain worsen blood circulation and provoke the neurocirculator spasm of muscles of eyes preceding development of destructive processes. In old age rheological properties of colloidal gel in the central departments worsen, on the periphery the colloid is condensed. By gravity the postponed crystals or collagenic masses in a retina exfoliate and collect in the center of a vitreous body.
The miopiya at which rounded shape of an eyeball is replaced ellipsoidal that leads to deformation of intraocular structures acts as the trigger of this pathology. The disease can be provoked by blow to the area of an eye-socket. The mechanical trauma leads to loss of integrity of gel weight, violation of primary structure of collagen and development of a gemoftalm against the background of damage of the vascular course. Patients with dekompensirovanny diabetes, an asthenopia and Parkinson's disease enter into risk group. Yatrogenny destruction is possible at injury of a vitreous body during surgery concerning a cataract.
Pathogenesis and classification
Distinguish full and partial destruction of a vitreous body. Most often destructive processes affect the central departments of colloidal gel. The first stage is formation of the cavity containing liquid and koagulirovanny mass of collagen. In the subsequent more and more fibrillyarny proteins gives in to coagulation and goes beyond education that leads to fluidifying of the gelatinous substance filling space between a crystalline lens and a retina. In it films and tyazh of various nature which can be fixed to an eye bottom are formed, becoming the reason of wrinkling and formation of solderings. The vitreous body decreases in volume and is deformed that provokes a tension of vitreoretinalny connections with the subsequent peeling of a retina.
In a form allocate threadlike, granular and crystal destruction. Atherosclerosis or the progressing miopiya acts as the trigger of a threadlike form. At development of inflammatory processes in an inside retinalny layer the granular centers of damage of a vitreous body are formed. In rare instances colloidal gel is damaged by the postponed crystals of cholesterol and a tirozin.
Symptoms and diagnostics
Patients note fotopsiya, , "veil" before eyes and decrease in visual acuity. A specific symptom of destruction are "front sights" most of which often appear at a view of the sky or the white monitor. The attempt to be focused on "front sights" leads to their movement or disappearance. Usually pathology develops gradually. Sudden emergence of black points before eyes is an early symptom of peeling of a retina or vitreous body.
For confirmation of destruction of a vitreous body it is necessary to carry out an oftalmoskopiya, ultrasonography of an eyeball, biomicroscopy, an optical coherent tomography, a vizometriya and a tonometriya. Empty cavities which often have an appearance of vertical cracks are defined by method of an oftalmoskopiya optically. A boundary membrane without specific changes, behind it fibrous structures of gray or white color are visualized. Full destruction is characterized by formation of a uniform cavity with scraps of fibrilla. Destruction of a boundary membrane at which lack of retrolentalny space is observed is possible. At localization of turbidity at edge of a retina specific changes do not come to light.
Using a slot-hole lamp, when carrying out biomicroscopy it is possible to find change of a consistence of colloidal gel and existence of flaky pomutneniye. At nitchaty destruction collagenic fibers acquire loop-shaped structure. Granular destruction is shown by a congestion of particles of the small extent of gray or brown color. At late stages of a disease congestions of grains in the form of conglomerates are visualized.
Ultrasonography is more informative method. The technique is recommended at the accompanying hemorrhages in a vitreous body, ultrasonography should be carried out in the V-scanning mode. The procedure allows to reveal a source of hemorrhage and ekhonegativny signals from crystal structures in a colloid. Fluidifying of a vitreous body is demonstrated by detection of mobility of crystals, granular conglomerates or congestions of collagenic fibers.
The Optical Coherent Tomography (OCT) of eyes is carried out at not informational content of other diagnostic techniques. When carrying out a research reduction of the size and change of a shape of a vitreous body, its turbidity and heterogeneity of structure is found. A contraindication to an optical coherent tomography is massive . Vizometriya allows to estimate extent of decrease in visual acuity. Slight increase of intraocular pressure is defined by method of a tonometriya.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Specific methods of treatment of destruction of a vitreous body are not developed. Tactics of the ophthalmologist depends on extent of defeat of colloidal gel and decrease in visual acuity. At insignificant violation of functions of an eye and identification of partial destruction conservative therapy and correction of a way of life is recommended. Patients should normalize the mode of a dream and wakefulness, to carry out gymnastics for eyes during the work at the computer or long reading. Conservative therapy consists in local purpose of iodide potassium for ensuring rassasyvayushchy effect and antioxidants for improvement of microcirculation of eyes (). It is orally recommended to accept and cinnarizine, promoting improvement of brain blood circulation. Reception of vasoprotectives and proofreaders of microcirculation is shown (the L-lysine ).
Surgical treatment is required at the expressed destruction of a vitreous body. In modern ophthalmology apply to aim crushing of large fragments of collagen . Operation is performed under local anesthesia. Before use of the special YAG laser pupils expand by means of midriatik of short action (). Violations of visual function after a vitreolizis of collagenic structures of a vitreous body are not observed. The course of surgery is at a loss at high mobility of pathological congestions in colloidal gel.
Total destruction is the indication to carrying out a vitrektomiya under local or general anesthesia. In the course of surgical intervention carry out removal of a vitreous body with use of the microsurgical equipment. At the first stage colloidal gel is divided into small sites which subject further aspirations. Intraocular pressure is normalized by introduction of the balanced salt solution, silicone oil or gas to an eyeball cavity.
Forecast and prevention
For prevention of destruction of a vitreous body it is regularly necessary to have examination of the ophthalmologist with obligatory carrying out an oftalmoskopiya, vizometriya and tonometriya. It is recommended to lower visual loading, to carry out remedial gymnastics for eyes, to eat the vitaminized food, to exclude from a diet food with the high content of animal fat. All patients with a miopiya should carry out actions for sight correction in due time. At a diabetic retinopathy consultation of the ophthalmologist is shown 2 times a year.
The forecast at destruction of a vitreous body in case of timely diagnostics and treatment favorable for life and working capacity. Even at late stages of a disease by means of a vitrektomiya it is possible to improve considerably visual acuity and quality of life of the patient.